Damage to the optic nerve. Optic nerve atrophy (partial and complete) - causes, symptoms, treatment and prevention

21.10.2019 -

This state- the final stage of damage optic nerve. This is not a disease, but rather a sign of a more serious disease. Possible causes include direct trauma, pressure or toxic damage to the optic nerve, and nutritional deficiencies.

Causes of optic nerve atrophy

The optic nerve is made up of nerve fibers that carry impulses from the eye to the brain. It contains approximately 1.2 million axons originating in retinal cells. These axons have a thick myelin sheath and cannot regenerate after injury.

In the case of degeneration of fibers in any of the departments of the optic nerve, its ability to transmit signals to the brain is impaired.

Regarding the causes of AD, scientific studies have established that:

Approximately 2/3 of the cases were bilateral.
most common cause bilateral ADS are intracranial neoplasms.
The most common cause of unilateral injury is traumatic brain injury.
Vascular factors are a common cause of AD in people over 40 years of age.

In children, causes of AD include congenital, inflammatory, infectious, traumatic, and vascular factors, including perinatal stroke, mass lesions, and hypoxic encephalopathy.

Consider the most common causes of AD:

Primary diseases affecting the optic nerve: chronic glaucoma, retrobulbar neuritis, traumatic optic neuropathy, formations that compress the optic nerve (eg, tumors, aneurysms).
Primary diseases of the retina, for example, occlusion of the central artery or central retinal vein.
Secondary diseases of the optic nerve: ischemic optic neuropathy, chronic neuritis or edema of the optic nerve.

Less common causes of AD:

Hereditary optic neuropathy (for example, Leber's optic neuropathy).
Toxic neuropathy, which can be caused by exposure to methanol, certain drugs (disulfiram, ethambutol, isoniazid, chloramphenicol, vincristine, cyclosporine, and cimetidine), alcohol abuse, and tobacco products, metabolic disorders (for example, severe renal failure).
Retinal degeneration (for example, retinitis pigmentosa).
Retinal storage diseases (eg, Tay-Sachs disease)
radiation neuropathy.
Syphilis.

Classification of optic nerve atrophy

There are several classifications of ADS.

According to the pathological classification, ascending (anterograde) and descending (retrograde) atrophy of the optic nerve is distinguished.

The ascending ADS looks like this:

In diseases with anterograde degeneration (eg, toxic retinopathy, chronic glaucoma), the process of atrophy begins in the retina and spreads towards the brain.
The rate of degeneration is determined by the thickness of the axons. Larger axons decay faster than smaller ones.

Descending optic atrophy is characterized by the fact that the process of atrophy begins in the proximal part of the axon and spreads towards the optic nerve head.

According to the ophthalmoscopic classification, there are:

Primary ADS. In diseases with primary atrophy (eg, pituitary tumor, optic nerve tumor, traumatic neuropathy, multiple sclerosis), degeneration of the optic nerve fibers leads to their replacement by columns of glial cells. On ophthalmoscopy, the optic nerve head is white with clear margins, and retinal blood vessels are normal.
Secondary ADS. In diseases with secondary atrophy (eg, edema or inflammation of the optic nerve head), degeneration of nerve fibers is secondary to edema of the optic nerve. With ophthalmoscopy, the optic disc has a gray or dirty gray color, its edges are fuzzy; retinal blood vessels may be altered.
Sequential ADS. In this form of atrophy (eg, retinitis pigmentosa, myopia, central retinal artery occlusion), the disc is waxy with well-defined margins.
Glaucoma atrophy is characterized by a bowl-shaped optic disc.
Temporary pallor of the optic disc can be seen in traumatic neuropathy or nutritional deficiencies, and is most common in patients with multiple sclerosis. The disc is pale in color with clear margins and normal vessels.

According to the degree of damage to the nerve fibers, there are:

Partial atrophy of the optic nerve - the process of degeneration affects not all fibers, but a certain part of them. This form of optic nerve subatrophy is characterized by incomplete loss of vision.
Complete atrophy of the optic nerve - the process of degeneration affects all nerve fibers, leading to blindness.

Symptoms of optic nerve atrophy

Visual impairment is the main symptom of optic nerve atrophy. The clinical picture depends on the cause and severity of the pathology. For example, with partial atrophy of the optic nerves of both eyes, there are bilateral symptoms deterioration of vision without its complete loss, manifested first by the loss of clarity and impaired color perception. When the tumor compresses the optic nerves, the visual fields may decrease. If left untreated, partial atrophy of the optic nerve often progresses to complete loss of vision.

Depending on the etiological factors, patients with AD may also have other signs that are not directly related to this pathology. For example, with glaucoma, a person may suffer from pain in the eyes.

Characterization of the clinical picture of AD is important in determining the cause of neuropathy. Rapid onset is characteristic of neuritis, ischemic, inflammatory, and traumatic neuropathy. Gradual progression over several months is characteristic of toxic neuropathy and atrophy due to nutritional deficiencies. Even more slowly (over several years) the pathological process develops in compressive and hereditary AD.

If a young patient complains of pain in the eyes associated with their movement, the presence of neurological symptoms (for example, paresthesia, ataxia, weakness in the limbs), this may indicate the presence of demyelinating diseases.

In older people with signs of AD, the presence of temporary vision loss, double vision (diplopia), fatigue, weight loss, and muscle pain may suggest ischemic neuropathy due to giant cell arteritis.

In children, a recent history of flu-like symptoms or a recent vaccination indicates parainfectious or post-vaccination optic neuritis.

Diplopia and facial pain suggest multiple cranial nerve neuropathy seen in inflammatory or neoplastic lesions of the posterior orbit and the anatomical region around the sella turcica.

Short-term blurred vision, diplopia and headaches indicate the possibility of increased intracranial pressure.

Diagnosis of optic nerve atrophy

The described clinical picture can be observed not only in AD, but also in other diseases. To establish correct diagnosis if you have problems with your eyesight, you should consult an ophthalmologist. He will spend comprehensive examination eye, including ophthalmoscopy, which can be used to examine the optic nerve head. With atrophy, this disc has a pale color, which is associated with a change in blood flow in its vessels.

To confirm the diagnosis, optical coherence tomography can be performed - an examination of the eyeball that uses infrared light waves for visualization. The ophthalmologist also evaluates color vision, the reaction of pupils to light, determines the sharpness and disturbance of the visual fields, and measures intraocular pressure.

It is very important to determine the cause of AD. For this purpose, the patient can undergo computed or magnetic resonance imaging of the orbits and brain, laboratory examination for the presence of genetic abnormalities or the diagnosis of toxic neuropathy.

How to treat optic nerve atrophy?

How to treat optic nerve atrophy? The importance of vision for a person cannot be overestimated. Therefore, in the presence of any symptoms of optic nerve atrophy, in no case should you resort to treatment on your own. folk remedies, contact a qualified ophthalmologist immediately.

It is necessary to start treatment at the stage of partial atrophy of the optic nerve, which allows many patients to maintain some vision and reduce the degree of disability. Unfortunately, with complete degeneration of nerve fibers, it is almost impossible to restore vision.

The choice of treatment depends on the cause of the disorder, for example:

Treatment of descending optic nerve atrophy caused by an intracranial tumor or hydrocephalus is aimed at eliminating compression of the nerve fibers by the neoplasm.
In case of inflammatory diseases of the optic nerve (neuritis) or ischemic neuropathy, intravenous administration corticosteroids.
With toxic neuropathy, antidotes are prescribed for those substances that caused damage to the optic nerves. If atrophy is caused medicines, their reception is stopped or the dose is adjusted.
Neuropathy due to nutritional deficiencies is treated with dietary modification and multivitamin preparations that contain the necessary good vision trace elements.
Possibly with glaucoma conservative treatment, aimed at reducing intraocular pressure, or performing a surgical operation.

In addition, there are methods of physiotherapy, magnetic, laser and electrical stimulation of the optic nerve, which are aimed at the maximum possible preservation of the functions of nerve fibers.

There are also scientific works that have shown the effectiveness of the treatment of AD with the introduction of stem cells. With the help of this still experimental technique, it is possible to partially restore vision.

Prognosis for ASD

The optic nerve is part of the central, not peripheral nervous system, which makes it impossible to regenerate after damage. Thus, AD is irreversible. Treatment of this pathology is aimed at slowing down and limiting the progression of the degeneration process. Therefore, every patient with optic nerve atrophy should remember that the only place where you can cure this pathology or stop its development is the ophthalmology departments in medical institutions.

The prognosis for vision and life in ADN depends on the cause of the disease and the degree of damage to the nerve fibers. For example, with neuritis, after the inflammatory process subsides, vision may improve.

Prevention

In some cases, the development and progression of AD can be prevented by proper treatment of glaucoma, toxic, alcohol and tobacco neuropathy, and by eating a nutritious and nutritious diet.

Atrophy of the optic nerve is a consequence of the degeneration of its fibers. It can be caused by many diseases, from glaucoma and circulatory disorders (ischemic neuropathy) to inflammation (eg, multiple sclerosis) and nerve-compressing masses (eg, intracranial tumors). Effective treatment possible only at the stage of partial atrophy of the optic nerve. The choice of method of therapy depends on etiological factors. In this regard, it is necessary to establish the correct diagnosis in time and direct all efforts to preserve vision.

Useful video about optic nerve atrophy

During atrophy, the nervous tissue experiences an acute lack of nutrients, which is why it ceases to perform its functions. If the process continues long enough, neurons begin to gradually die off. Over time, it affects an increasing number of cells, and in severe cases, the entire nerve trunk. It will be almost impossible to restore the function of the eye in such patients.

What is the optic nerve?

The optic nerve belongs to the cranial peripheral nerves, but in essence it is not a peripheral nerve, neither in origin, nor in structure, nor in function. This is white matter brain, pathways that connect and transmit visual sensations from the retina to the cerebral cortex.

The optic nerve delivers nerve messages to the area of the brain responsible for processing and perceiving light information. It is the most important part of the whole process of converting light information. Its first and most significant function is to deliver visual messages from the retina to the areas of the brain responsible for vision. Even the smallest injury to this area can have severe complications and consequences.

Causes

The development of optic nerve atrophy is caused by various pathological processes in the optic nerve and retina (inflammation, dystrophy, edema, circulatory disorders, the action of toxins, compression and damage to the optic nerve), diseases of the central nervous system, general diseases of the body, hereditary causes.

There are the following types of disease:

Congenital atrophy - manifests itself at birth or a short period of time after the birth of a child.
Acquired atrophy - is a consequence of diseases of an adult.

Factors leading to optic nerve atrophy can be eye diseases, CNS lesions, mechanical damage, intoxication, general, infectious, autoimmune diseases, etc. Optic nerve atrophy appears as a result of obstruction of the central and peripheral retinal arteries that feed the optic nerve, and also it is the main symptom of glaucoma.

The main causes of atrophy are:

Heredity
congenital pathology
eye diseases ( vascular diseases retina, as well as the optic nerve, various neuritis, glaucoma, retinitis pigmentosa)
Intoxication (quinine, nicotine and other drugs)
Alcohol poisoning (more precisely, alcohol surrogates)
Viral infections (ARI, influenza)
Pathology of the central nervous system (brain abscess, syphilitic lesion, meningitis, skull trauma, multiple sclerosis, tumor, syphilitic lesion, skull trauma, encephalitis)
Atherosclerosis
Hypertonic disease
Intraocular pressure
Profuse bleeding

The cause of primary descending atrophy is vascular disorders with:

hypertension;
atherosclerosis;
spinal pathology.

Lead to secondary atrophy:

acute poisoning (including alcohol surrogates, nicotine and quinine);
inflammation of the retina;
malignant neoplasms;
traumatic injury.

Atrophy of the optic nerve can be provoked by inflammation or dystrophy of the optic nerve, its compression or injury, which led to damage to the nerve tissue.

Types of disease

Atrophy of the optic nerve of the eye is:

Primary atrophy (ascending and descending), as a rule, develops as an independent disease. Descending optic nerve atrophy is the most commonly diagnosed. This type of atrophy is a consequence of the fact that the nerve fibers themselves are affected. It is transmitted by recessive type by inheritance. This disease is linked exclusively to the X chromosome, which is why only men suffer from this pathology. It manifests itself in flight.
Secondary atrophy usually develops after the course of a disease, with the development of stagnation of the optic nerve or a violation of its blood supply. This disease develops in any person and at absolutely any age.

In addition, the classification of forms of optic nerve atrophy also includes such variants of this pathology:

Partial atrophy of the optic nerve

A characteristic feature of the partial form of optic nerve atrophy (or initial atrophy, as it is also defined) is the incomplete preservation of visual function (vision itself), which is important with reduced visual acuity (due to which the use of lenses or glasses does not improve the quality of vision). Residual vision, although it is subject to preservation in this case, however, there are violations in terms of color perception. Saved areas in the field of view remain accessible.

Complete atrophy

Any self-diagnosis is excluded - only specialists with the proper equipment can make an accurate diagnosis. This is also due to the fact that the symptoms of atrophy have much in common with amblyopia and cataracts.

In addition, optic nerve atrophy can manifest itself in a stationary form (that is, in a complete form or a non-progressive form), which indicates a stable state of actual visual functions, as well as in the opposite, progressive form, in which the quality of visual acuity inevitably decreases.

Symptoms of atrophy

The main sign of optic nerve atrophy is a decrease in visual acuity that cannot be corrected with glasses and lenses.

With progressive atrophy, a decrease in visual function develops over a period of several days to several months and may result in complete blindness.
In case of partial atrophy of the optic nerve pathological changes reach a certain point and do not develop further, in connection with which vision is partially lost.

With partial atrophy, the process of vision deterioration stops at some stage, and vision stabilizes. Thus, it is possible to distinguish progressive and complete atrophy.

Alarming symptoms that may indicate that optic nerve atrophy is developing are:

narrowing and disappearance of visual fields (lateral vision);
the appearance of "tunnel" vision associated with color sensitivity disorder;
the occurrence of livestock;
manifestation of the afferent pupillary effect.

The manifestation of symptoms can be unilateral (in one eye) and multilateral (in both eyes at the same time).

Complications

The diagnosis of optic nerve atrophy is very serious. At the slightest decrease in vision, you should immediately consult a doctor so as not to miss your chance for recovery. In the absence of treatment and with the progression of the disease, vision may disappear completely, and it will be impossible to restore it.

In order to prevent the occurrence of pathologies of the optic nerve, it is necessary to carefully monitor your health, undergo regular examinations by specialists (rheumatologist, endocrinologist, neurologist, ophthalmologist). At the first sign of visual impairment, you should consult an ophthalmologist.

Diagnostics

Optic nerve atrophy serious illness. In case of even the slightest decrease in vision, it is necessary to visit an ophthalmologist so as not to miss precious time for the treatment of the disease. Any self-diagnosis is excluded - only specialists with the proper equipment can make an accurate diagnosis. This is also due to the fact that the symptoms of atrophy have much in common with amblyopia and cataracts.

An examination by an ophthalmologist should include:

visual acuity test;
examination through the pupil (expand with special drops) of the entire fundus;
spheroperimetry (accurate determination of the boundaries of the field of view);
laser dopplerography;
assessment of color perception;
craniography with a picture of the Turkish saddle;
computer perimetry (allows you to identify which part of the nerve is affected);
video ophthalmography (allows you to identify the nature of damage to the optic nerve);
computed tomography, and magnetic nuclear resonance(specify the cause of the disease of the optic nerve).

Also, a certain information content is achieved to compile a general picture of the disease through laboratory methods research, such as a blood test (general and biochemical), testing for borreliosis or syphilis.

Treatment of atrophy of the optic nerve of the eye

Treatment of optic nerve atrophy is a very difficult task for physicians. You need to know that destroyed nerve fibers cannot be restored. One can hope for some effect from the treatment only when the functioning of the nerve fibers that are in the process of destruction, which still retain their vital activity, is restored. If you miss this moment, then the vision in the sore eye can be lost forever.

In the treatment of optic nerve atrophy, the following actions are performed:

Biogenic stimulants are prescribed ( vitreous body, aloe extract, etc.), amino acids (glutamic acid), immunostimulants (eleutherococcus), vitamins (B1, B2, B6, ascorutin) are prescribed to stimulate the restoration of altered tissue, as well as to improve metabolic processes.
Vasodilators are prescribed (no-shpa, diabazol, papaverine, sermion, trental, zufillin) - to improve blood circulation in the vessels that feed the nerve
Phezam, emoxipin, nootropil, cavinton are prescribed to maintain the work of the central nervous system.
To accelerate the resorption of pathological processes - pyrogenal, preductal
Appointed hormonal preparations to stop the inflammatory process - dexamethasone, prednisolone.

Drugs are taken only as directed by a doctor and after an accurate diagnosis has been established. Only a specialist can choose the optimal treatment, taking into account concomitant diseases.

Patients who have completely lost their sight or have lost it to a significant extent are assigned an appropriate course of rehabilitation. It is focused on compensating and, if possible, eliminating all those restrictions that arise in life after suffering atrophy of the optic nerve.

The main physiotherapeutic methods of therapy:

color stimulation;
light stimulation;
electrical stimulation;
magnetic stimulation.

To achieve a better result, magnetic, laser stimulation of the optic nerve, ultrasound, electrophoresis, oxygen therapy can be prescribed.

The earlier treatment is started, the better the prognosis of the disease. Nervous tissue is practically unrecoverable, so the disease cannot be started, it must be treated in a timely manner.

In some cases, with atrophy of the optic nerve, surgery and surgery may also be relevant. According to research, the optic fibers are not always dead, some may be in a parabiotic state and can be brought back to life with the help of a professional with extensive experience.

The prognosis of optic nerve atrophy is always serious. In some cases, you can count on the preservation of vision. With developed atrophy, the prognosis is unfavorable. Treatment of patients with atrophy of the optic nerves, whose visual acuity was less than 0.01 for several years, is ineffective.

Prevention

Optic nerve atrophy is a serious disease. To prevent it, you need to follow some rules:

Consultation with a specialist at the slightest doubt in the visual acuity of the patient;
A warning various kinds intoxication
timely treat infectious diseases;
do not abuse alcohol;
monitor blood pressure;
prevent eye and craniocerebral injuries;
repeated blood transfusion for profuse bleeding.

Timely diagnosis and treatment can restore vision in some cases, and slow down or stop the progression of atrophy in others.

Discussion: 4 comments

My brother was diagnosed with this 5 years ago. Today I'll send him an article, let him read how dangerous it is

And my hooligan neighbor put her head against the wall with her head ... This is a frequent thing with mine. atrophy, which is still fresh after completed neuritis. ((((What will happen to me now ....

My husband is diagnosed with secondary atrophy of both eyes, alas, doctors cannot help us with anything. Is there a cure for this disease please help. Where can you get treatment?

Very clearly explained, thanks

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Optic nerve damage

Damage to the optic nerve most often occurs as a result of a violation of its integrity or infringement by bone fragments, hematoma of the orbit, hemorrhage between the sheaths of the optic nerve. Infringement or rupture is possible at different levels: in the orbit, in the optic nerve canal, in the cerebral zone. Symptoms of damage to the optic nerve - a decrease in visual acuity and a change in the field of view.

Infringement of the optic nerve is characterized by a decrease in visual acuity, the picture of thrombosis of the central retinal vein can be determined in the fundus, and in the case of a more severe injury, occlusion of the central retinal artery.

The rupture of the optic nerve may be partial or complete. In the first days after the injury, the fundus of the eye may be unchanged. Therefore, the patient's complaints about a sharp decrease or complete loss of vision may cause the physician to suspect aggravation. In the future, a picture of optic nerve atrophy develops in the fundus. The closer the gap is localized to the eyeball, the earlier changes occur in the fundus. With incomplete atrophy of the optic nerve, reduced vision and part of the visual field may be preserved.

Detachment of the optic nerve occurs in the case of severe blunt trauma in the medial part of the orbit (with the end of a stick, etc.), if the posterior part of the eye suddenly shifts strongly outward. The detachment is accompanied by a complete loss of vision, a large hemorrhage is first determined in the fundus, and subsequently a tissue defect in the form of a depression surrounded by hemorrhage.

Treatment. Assign hemostatic and dehydration therapy; if there is a suspicion of a hematoma of the orbit, a surgical incision is possible - orbitotomy. In the future, in conditions of partial atrophy of the optic nerve, repeated courses of ultrasound, vasodilating and stimulating therapy are carried out.

Wounds of the organ of vision. Damage to the organ of vision is divided into injuries of the orbit, appendages of the eye and the eyeball.

Wounds of the orbit, especially gunshot wounds, in their complexity, variety and characteristics, belong to extremely severe injuries. They can be isolated - with or without a foreign body in the orbit, combined - with simultaneous damage to the eyeball, combined - if the injury to the orbit is accompanied by injury to the craniocerebral region, face, paranasal sinuses.

All patients with injuries of the orbit are given x-rays in two projections.

Depending on the type of weapon (heavy blunt object, knife, glass, awl) that was injured, damage to the soft tissues of the orbit can be torn, cut, or stabbed.

Peculiarities lacerations: loss of fatty tissue, damage to the external muscles of the eye, injury to the lacrimal gland, ophthalmoplegia, exophthalmos may occur.

Treatment. First, the wound is revised - its size and depth are determined, as well as its relation to the bone walls of the orbit. The ophthalmologist must first of all find out if it extends deep into the cranial cavity and paranasal sinuses. Then they resort to preliminary surgical treatment of the soft tissues of the orbit - the contaminated edges of the wound are economically cut off within 0.1-1 mm, the wound is washed with a solution of furacillin, antibiotics or hydrogen peroxide. According to indications, wound plasty is performed with adjacent tissues, catgut or other absorbable sutures are applied to damaged fascia, ligaments or muscles, silk sutures are applied to the skin.

Signs of stab wounds: exophthalmos, ophthalmoplegia, ptosis, which indicate a deep wound channel and trauma to the nerve trunks and vessels near the top of the orbit. One of the factors that determine the severity of stab wounds is damage to the optic nerve.

Treatment involves, first of all, a thorough revision of the wound channel and preliminary surgical treatment. soft tissues cut into 2-2.5 cm, the wound channel is examined carefully, in compliance with the principle of maximum tissue preservation. In the absence of a foreign body in the orbit and, after excluding the penetration of the wound channel into the cranial cavity or paranasal sinuses, the wound is sutured.

In case of incised wounds, the wound is revised and preliminary surgical treatment is carried out with the restoration of the anatomical ratios of the soft tissues of the orbit. The presence of a foreign body in the orbit significantly complicates the course of the traumatic process. Severe inflammatory tissue edema, exophthalmos, the presence of a wound passage from which pus is released indicate a possible entry of a wooden foreign body into the orbit. To determine its localization, x-ray examination or computed tomography, additional data can be obtained by ultrasound, including ultrasound scanning eye sockets.

After clarifying the localization of the foreign body in the orbit, it is removed by a simple orbitotomy, in the presence of magnetic fragments, magnets are used.

Fractures of the bony walls of the orbit are observed in almost half of all injuries of the orbit in peacetime. Fracture treatment is carried out jointly by an ophthalmologist, a neurosurgeon, an otolaryngologist and a dentist. Surgical treatment of wounds of the orbit in early dates after an injury, it makes it possible not only to eliminate a cosmetic defect, but also to restore the patient's vision.

Classification of damage to the optic nerve

1) open damage- damage to the optic nerve in case of penetrating wounds of the skull and/or orbit.

2) Closed damage - damage to the optic nerve as a result of blunt trauma to the skull and facial skeleton.

1) Direct damage occurs as a result of direct contact of the traumatic agent with the ON.

2) Indirect damage occurs as a result of shock or compression effect of a traumatic agent on distant or surrounding bone structures. Characteristic is the decrease in vision after injury in the absence of signs of damage to the eyeball, which could lead to a decrease in visual functions.

1) Primary damage - damage in which there are morphological changes caused by mechanical energy, and occurred at the time of injury:

1.1. Hemorrhages in the nerve, membranes and intershell spaces of the nerve;

1.2. Contusion necrosis; 1.3 Gap:

a) anatomical (full or partial);

2.2. Necrosis due to local compression of the vessel or circulatory vascular insufficiency;

2.3. Nerve infarction due to vascular occlusion (spasm, thrombosis).

1) Anterior damage - damage to the intraocular region (ON disk) and part of the intraorbital region to the point of entry into it of the central retinal artery (RAS), while pathology is always detected in the fundus.

1) Unilateral damage to the AP.

2) Damage to the visual pathway at the base of the brain:

2.1. Bilateral damage to the optic nerve;

2.2. Chiasm damage;

2.3. Combined damage to the ON and chiasm;

2.4. Combined damage to the ON, chiasm and optic tract.

1) Damage with the presence of a fracture of the walls of the optic canal.

2) Damage with the presence of fractures of adjacent bone structures (the wall of the orbit, the anterior clinoid process, the lesser wing of the sphenoid bone).

3) Damage against the background of fractures of distant bone structures of the skull and facial skeleton.

4) Damage without the presence of fractures of the bone structures of the skull and facial skeleton.

1) For anterior injuries:

1.1. Violation of blood circulation in PAS;

1.2. Anterior ischemic neuropathy;

1.3. Evulsion (separation of the optic nerve from the eyeball);

2) For posterior injuries:

Concussion is defined as "a clinical syndrome characterized by an immediate and transient impairment of neurological function associated with exposure to a mechanical factor."

Contusion is defined histologically as "a structural tissue injury characterized by extravasation of blood and cell death".

The structure of the morphological substrate is dominated by secondary (ischemic) damage due to mechanical compression of the nerve. The compression of the ON is characterized by a progressive or delayed deterioration of visual functions after injury. With a delayed type of vision loss, visual functions are not changed immediately after the injury, and their primary deterioration is noted only after a while. In the progressive type of visual loss, the primary deterioration in visual function is observed immediately after the injury, while there is a partial visual deficit, which increases over time (secondary impairment). The period of time from the moment of injury to the primary or secondary deterioration of visual function (the “luminous gap”) can take from several minutes and hours to several days after injury. A “light gap”, regardless of its duration, is an indication of the absence of an anatomical break in the ON and the presence of potentially reversible morphological changes.

1) the upper wall of the orbit;

2) The walls of the visual canal;

3) Anterior inclined process.

1.1. Retrobulbar hematoma;

1.2. Subperiosteal hematoma of the orbit.

2) Shell hematoma of the ON.

3.1. Frontobasal hematoma;

3.2. Convexital hematoma of the frontotemporal region.

1) Callus;

2) Scar tissue;

3) Adhesive arachnoiditis.

Injury to the optic nerve - direct damage to the optic nerve resulting from direct contact with a traumatic agent. Wounding of the optic nerve usually leads to its complete irreversible damage, with an anatomical interruption and the development of immediate amaurosis. However, it is also possible partial damage. In this case, there is irreversible damage to some of the optic fibers, but intact fibers retain the potential to restore their function. In those cases where the direct impact of a traumatic agent on the ON does not lead to a violation of its integrity, a tangential wound occurs.

At present, in most observations, the establishment clinical forms damage to the AP presents great difficulties. There is much in common in the presented characteristics of clinical manifestations. There are certain difficulties in their differentiation. At the same time, for practical purposes (indications for ON decompression, prognosis, rehabilitation potential, expert assessment, determination of the severity of TBI, etc.), clear gradations are required according to unified criteria. As the latter, visual impairments can serve. Considering that they vary widely, all damage to the ON is divided into three degrees of severity, respectively. visual disturbances: light, moderate, heavy (Table 2-2).

Criteria for assessing the severity of damage to the ON

In the case of an immediate type of visual impairment, the severity of the optic nerve damage is assessed by the initial level of visual functions immediately after the injury. The severity of progressive or delayed types of visual disturbances must be assessed in dynamics according to their maximum severity in the acute period of injury.

2.1. Partial excitation conduction block;

2.2. Complete excitation conduction block.

3.1. Reversible - functional interruption of the ON;

3.2. Partially reversible - morpho-functional interruption of the ON;

3.3. Irreversible - morphological interruption of the ON.

Rice. 2 - 28. Classification of damage to the optic nerve.

Examples of formulations of the diagnosis in relation to damage to the ON:

Closed indirect light damage to the right optic nerve;

Closed indirect severe damage to the right ON and chiasm;

Closed indirect severe damage to the ON from 2 sides;

Closed indirect severe injury (contusion) of the intracanalicular part of the right ON, linear fracture upper wall right visual channel;

Closed indirect severe injury (contusion and compression) of the intracanalicular part of the right ON;

Closed indirect severe dislocation injury (compression) of the intracranial part of the right ON;

Open direct severe damage (wound) of the intraorbital part of the right ON with a complete anatomical break;

Open indirect severe injury (contusion) of the intraorbital part of the right ON.

To bruises of the brain include focal macrostructural damage to its substance resulting from an injury.

According to the unified clinical classification of TBI adopted in Russia, focal brain contusions are divided into three degrees of severity: 1) mild, 2) moderate, and 3) severe.

Diffuse axonal brain injuries include complete and / or partial widespread ruptures of axons in frequent combination with small-focal hemorrhages, caused by an injury of a predominantly inertial type. At the same time, the most characteristic territories of the axonal and vascular beds.

In most cases, they are a complication of hypertension and atherosclerosis. Less commonly, they are caused by diseases of the valvular apparatus of the heart, myocardial infarction, severe anomalies of the cerebral vessels, hemorrhagic syndrome and arteritis. There are ischemic and hemorrhagic strokes, as well as p.

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With traumatic brain injury (TBI), damage to the optic nerve (ON) often occurs. The human eye is a very fragile instrument that can be easily damaged. And we are talking not only about its external part, but also about its internal. Most often, injury occurs as a result of a strong mechanical impact on the head area. This leads to many negative consequences, the degree of complexity of which depends on the level of damage and the type of TBI.

general information

Experts note that such a problem as damage to the optic nerve is observed in approximately 5% of victims with a traumatic brain injury. Most often, there is a lesion of the intracanal nerve section.

Basically, this type of injury occurs after a blow in the frontal or frontal-temporal part of the head. At the same time, experts note that the severity of skull damage does not always correlate with the level of damage to the optic nerve.

Therefore, it cannot be said that swipe on the head will necessarily lead to complete or partial loss of vision. In turn, even a minor injury at first glance can cause a strong deterioration in the visual process if the blow falls on a certain area.

The greatest danger is the injury to the frontal part of the head. Therefore, such blows must be avoided without fail so as not to lose sight.

Professionals argue that with a severe lesion of the fronto-orbital region, maximum nerve damage is possible, resulting in complete loss of vision and even amaurosis.

Some patients also suffer from loss of consciousness. But for some, blows to the frontal part of the head are reflected only by a deterioration in the visual process. This is clear sign ZN damage.

Causes of damage to the optic nerve

ZN plays a very important role in the human body. This is a special transmitter that moves signals from the retina to the brain. The optic nerve is made up of millions of fibers, which in total are 50 mm long. This is a very vulnerable, but important structure that can be easily damaged.

As already noted, the most common cause of damage to the optic nerve is head trauma. However, this is far from the only possible factor in the disruption of signal transport. This may be the problem of intrauterine development, when the fetus, under the influence of certain processes, has an incorrect formation of the organs of vision.

In addition, inflammation can lead to damage to the optic nerve, which can concentrate in the area of the eyes or brain. Both stagnation and atrophy have a negative impact on the ON. The latter may have a different origin.

Most often, it becomes a complication after a traumatic brain injury. But sometimes atrophic processes in the eyes occur due to poisoning and severe intoxication of the body.

Intrauterine damage to the ON

There can be many reasons for the appearance of lesions of the optic nerve. Therefore, if your vision deteriorates, you should definitely consult a specialist. The doctor prescribes a qualitative examination, and then determines the cause of the pathology.

With the right approach and appropriate treatment, you can achieve good results and restore the visual process to normal limits. The diagnosis is made only after a thorough examination of the patient and all the necessary tests. Each type of optic nerve injury has its own symptoms.

In the case when a patient has a traumatic brain injury, the cause of damage to the optic nerve can be easily determined. In this case, the patient must receive the correct treatment, otherwise the visual function may no longer be restored.

But there are situations when it is very difficult to determine the cause of damage to the AP. For example, when a patient suffers from a pathology that originates even during fetal development, it can be difficult to immediately make a diagnosis.

The formation of the optic nerve and many other elements responsible for the process of vision occurs in the period from 3 to 10 weeks of pregnancy. If the expectant mother at this time suffers any disease or her body is exposed to certain negative factors, the baby may develop congenital atrophy of the optic nerve.

Experts share 6 forms of this disease. Almost all of them have similar general symptoms. Initially, there is a strong drop in visual functions. In addition, the patient is always diagnosed with a change in the structure of small vessels, that is, patients suffer from microangiopathy.

Color perception and peripheral vision with abnormal development of the optic nerve will differ significantly from how people without such pathologies see the world.

With abnormal intrauterine development of MN, problems with the visual process remain for life, and it is impossible to completely cure the pathology. People with this diagnosis often suffer from various complications.

Incorrect visual perception of the external world makes patients nervous and irritable, as well as prone to migraines.

Inflammatory damage

Acquired vision problems can be caused by inflammation. The optic nerve is a very fragile structure, therefore, under the influence of certain factors, it suffers very much and quickly fails. If a person encounters a serious inflammatory process that will be localized in the head, the optic nerve may be injured, which will cause a deterioration in the visual function of the body.

Any inflammation is dangerous for vision. It can be a lesion of the brain, and the eyeball, and even the nose. Experts strongly recommend not to ignore the symptoms of the pathological process in the sinuses, throat and ear. Incorrect or missing treatment can cause damage to the optic nerve.

AT medical practice there were also situations when banal caries led to blindness. Therefore, any inflammation must be treated, and this must be done in a timely manner in order to prevent complications.

Dangerous microorganisms can penetrate the vitreous body, and then move on. As a result, the inflammatory process passes to the eyes, and this can lead to complete damage to the optic nerve and total blindness. If the ON is partially damaged, the patient is likely to be diagnosed with atrophy.

A similar phenomenon is expressed in a strong deterioration or complete loss of vision. In addition, injury to blood vessels always occurs due to tissue swelling. But similar phenomena are also characteristic of many other diseases, so it is often difficult to make a correct diagnosis.

However, if the patient has caries, otitis media, sinusitis, or other inflammatory processes, it can be assumed that vision problems are associated with this.

Non-inflammatory damage

If any stagnant phenomenon occurs in the human body, which is most often associated with a violation of pressure, the patient may experience nerve damage with subsequent atrophy. An increase in intracranial pressure can occur for several reasons.

One of the most dangerous factors causing congestion in the skull is an oncological neoplasm. But even benign tumors can put pressure on the organs of vision, which will lead to pinching and damage to the optic nerve.

The cause of a non-inflammatory process that provokes an injury to the optic nerve may be swelling of the brain, a violation of the structure of the bone structure, and even cervical osteochondrosis. All this can increase intracranial pressure. If it is too high, nerve damage will occur.

Experts note that partial atrophy is most often a symptom of a non-inflammatory lesion of the optic nerve. That is, vision deteriorates, but does not disappear completely. As a rule, the patient feels problems with the visual process intermittently.

Complaints occur only at the stage when there is a strong increase in intracranial pressure. On examination, specialists often note hemorrhages that appear with strokes. However, if the pressure is very high, the eyes may turn completely red.

The danger of this phenomenon lies in the fact that its symptoms are rather mild at the first stage. Therefore, a person can simply ignore them. But already at this time damage and atrophy of the optic nerve will be noted. Therefore, when the first problems with vision appear, you should definitely consult a doctor.

If you do not solve the problem of intracranial pressure in a timely manner and do not get rid of the negative factor that provokes this process, count on full recovery not worth the view. Ignoring unpleasant symptoms often causes complete blindness, so it is imperative to treat non-inflammatory damage to the optic nerve and prevent its atrophy.

Mechanical damage

Such phenomena are very dangerous for the visual process. They meet quite often. For example, people who get into car accidents often suffer from this. Here, in most cases, there is such an injury as a blow to the forehead, and this can threaten with complete loss of vision.

However, experts consider mechanical damage MN is not only traumatic brain injury, but also exposure to toxins. Intoxication of the body, poisoning with alcohol, nicotine and various poisons is considered very dangerous. These cases are characterized by certain types of symptoms.

Exposure to harmful substances causes stomach problems, leading to nausea and vomiting, hearing loss and permanent damage to the optic nerve. Such changes in the body occur quickly and in a complex.

In addition, damage to the optic nerve can also be associated with previous diseases or chronic illnesses. If the patient suffers from diabetes or hypertension, or has recently suffered syphilis, it is possible that nerve damage will be one of the complications. That is why, with such diagnoses, patients often note sharp deterioration visual function.

Initially, peripheral vision is damaged. The patient may not immediately pay attention to this problem, but already on this stage there is a serious damage to the nerve and its gradual atrophy. If ignored initial symptoms, over time, a person will no longer see the full picture normally.

Certain areas simply fall out of sight, and when you try to move your eyes, the strongest will be noted. pain symptom. Complications can be severe headaches and color blindness.

Such phenomena indicate that a person has big problems that need to be urgently treated. If a patient has been diagnosed with damage to the optic nerve, it is important for him to receive correct therapy. It should be aimed primarily at eliminating the cause of the pathology. Until recently, people with such a diagnosis could not count on a complete restoration of vision.

Modern medicine offers effective solutions to eliminate pathology. However, some patients cannot be helped. Most often, congenital damage to the optic nerve and the most neglected cases are not subject to treatment. Therefore, do not delay with an appeal to an ophthalmologist. Self-diagnosis and ignoring the recommendations of a specialist can lead to complete atrophy of the optic nerve and total blindness.

Treatment

In order to eliminate the problem with damage to the optic nerve, it is necessary to conduct a comprehensive diagnosis. Based on the data obtained and after identifying the main cause of the pathology, it will be possible to prescribe the correct treatment procedures.

It must be borne in mind that nerve damage is not an independent disease. This problem always has an additional cause that must be eliminated. Otherwise, you should not count on improving visual function.

Experts strongly recommend that at the first deterioration of vision immediately undergo a diagnosis and begin treatment. This is the only opportunity not to miss the moment when you can solve the problem with medication. Often medical therapy aims to relieve swelling and reduce intracranial pressure.

Basically, to stimulate blood circulation in the brain and reduce edema, No-shpu, Papaverine, Eufilin or Galidol are prescribed. In addition, anticoagulants such as Ticlid and Heparin can be used. Have a positive impact vitamin complexes and biogenic stimulants.

However, if the optic nerve lesion was caused by a traumatic brain injury, the patient may need surgery. Without surgical intervention it is impossible to get rid of a pinched nerve. Also, the problem cannot be solved without surgery if the damage to the optic nerve is caused by pressure on the organs of vision by the tumor.

Any medications for damage to the optic nerve should be prescribed by a doctor only after a thorough examination of the patient. Self-treatment for such a complex problem as visual impairment due to trauma to the optic nerve is categorically unacceptable. You need to be very careful with folk remedies. Their reception may not give the desired result, and the time that could be spent on complete treatment, will be missed.

Experts note that such a problem as damage to the optic nerve is observed in approximately 5% of victims with a traumatic brain injury. Most often, there is a lesion of the intracanal nerve section.

Therefore, it cannot be said that a strong blow to the head will necessarily lead to complete or partial loss of vision. In turn, even a minor injury at first glance can cause a strong deterioration in the visual process if the blow falls on a certain area.

The greatest danger is the injury to the frontal part of the head. Therefore, such blows must be avoided without fail so as not to lose sight.

Professionals argue that with a severe lesion of the fronto-orbital region, maximum nerve damage is possible, resulting in complete loss of vision and even amaurosis.

Some patients also suffer from loss of consciousness. But for some, blows to the frontal part of the head are reflected only by a deterioration in the visual process. This is a clear sign of damage to the AP.

Causes of damage to the optic nerve

ZN plays a very important role in the human body. This is a special transmitter that moves signals from the retina to the brain. The optic nerve is made up of millions of fibers, which in total are 50 mm long. This is a very vulnerable, but important structure that can be easily damaged.

Most often, it becomes a complication after a traumatic brain injury. But sometimes atrophic processes in the eyes occur due to poisoning and severe intoxication of the body.

Intrauterine damage to the ON

There can be many reasons for the appearance of lesions of the optic nerve. Therefore, when you need to contact a specialist. The doctor prescribes a qualitative examination, and then determines the cause of the pathology.

Color perception and peripheral vision with abnormal development of the optic nerve will differ significantly from how people without such pathologies see the world.

Incorrect visual perception of the external world makes patients nervous and irritable, as well as prone to migraines.

Inflammatory damage

Any inflammation is dangerous for vision. It can be a lesion of the brain, and the eyeball, and even the nose. Experts strongly recommend not to ignore the symptoms of the pathological process in the sinuses, throat and ear. Incorrect or missing treatment can cause damage to the optic nerve.

In medical practice, there were also such situations when banal caries led to blindness. Therefore, any inflammation must be treated, and this must be done in a timely manner in order to prevent complications.

However, if the patient has caries, otitis media, sinusitis, or other inflammatory processes, it can be assumed that vision problems are associated with this.

Non-inflammatory damage

If you do not solve the problem of intracranial pressure in a timely manner and do not get rid of the negative factor that provokes this process, you should not count on a complete restoration of vision. Ignoring unpleasant symptoms often causes complete blindness, so it is imperative to treat non-inflammatory damage to the optic nerve and prevent its atrophy.

Mechanical damage

However, experts attribute not only craniocerebral injuries to mechanical damage to the optic nerves, but also exposure to toxins. Intoxication of the body, poisoning with alcohol, nicotine and various poisons is considered very dangerous. These cases are characterized by certain types of symptoms.

Exposure to harmful substances causes stomach problems, leading to nausea and vomiting, hearing loss and permanent damage to the optic nerve. Such changes in the body occur quickly and in a complex.

Initially, peripheral vision is damaged. The patient may not immediately pay attention to this problem, but already at this stage there is a serious damage to the nerve and its gradual atrophy. If you ignore the initial symptoms, over time, a person will no longer see the full picture normally.

Certain areas simply fall out of sight, and when you try to move your eyes, a strong pain symptom will be noted. Complications can be severe headaches and color blindness.

Such phenomena indicate that a person has big problems that need to be urgently treated. If the patient is diagnosed with damage to the ON, it is important for him to receive the correct therapy. It should be aimed primarily at eliminating the cause of the pathology. Until recently, people with such a diagnosis could not count on a complete restoration of vision.

Treatment

Experts strongly recommend that at the first deterioration of vision immediately undergo a diagnosis and begin treatment. This is the only opportunity not to miss the moment when you can solve the problem with medication. Most often, therapeutic therapy is aimed at removing puffiness and reducing intracranial pressure.

Basically, to stimulate blood circulation in the brain and reduce edema, No-shpu, Papaverine, Eufilin or Galidol are prescribed. In addition, anticoagulants such as Ticlid and Heparin can be used. Vitamin complexes and biogenic stimulants have a positive effect.

However, if the optic nerve lesion was caused by a traumatic brain injury, the patient may need surgery. Without surgery, it is impossible to get rid of a pinched nerve. Also, the problem cannot be solved without surgery if the damage to the optic nerve is caused by pressure on the organs of vision by the tumor.

Video

Optic neuritis(optical neuritis) is a pathology that is characterized by the course of the inflammatory process in the optic nerve and damage to its tissue and membrane. There are two forms of the disease - intrabulbar and. More often, the disease develops against the background of fiber destruction caused by neurological disorders and causes a deterioration in visual functions and a number of other symptoms.

Structure and functions

To represent the process neuritis ophthalmic nerve it is necessary to consider its structure and functions. It is made up of axons of neurons(processes) that come from the retina. The nerve, which consists of more than 1 million fibers, transmits signals in the form of impulses to visual center brain. He takes its beginning behind the disc of the organ of vision.

The area inside the retina, where the optic nerves are located, is the name of intrabulbar, or intraorbital. The site where the fibers pass into the cranium is known as the retrobulbar.

In neurology, the optic nerve performs several functions:

provides the ability of the eye to distinguish objects of various sizes (visual acuity);
provides the ability to distinguish colors;
defines the visibility zone (the boundaries of the field of view).

If this ailment of an inflammatory nature develops, then the functional abilities of the eye decrease at the same time.

Neuritis of the eye is not completely curable. This is due to the fact that the decrease in visual functions causes the degeneration of nerve fibers that cannot be restored.

Kinds

Classification pathology of the optic nerve is based on the etiology of the development of the disease and the localization of the inflammatory process. According to the first sign, neurosis is divided into:

toxic;
ischemic;
autoimmune;
parainfectious;
infectious;
demyelinating.

The parainfectious form develops against the background of an infectious lesion of the body or an abnormal reaction to the vaccine. pathology is due to acute violation cerebral circulation caused by the course of diseases of the cardiovascular system (pressure, hypertension), diabetes mellitus, atherosclerosis, blood diseases and others.

Poisoning with chemical compounds, methyl alcohol, pesticides of various classes and other toxic and volatile toxic substances leads to toxic optic neuritis.

Depending on the localization of the inflammatory process, intrabulbar (papillitis) and retrobulbar forms of the disease are distinguished. The first type of neuritis occurs with changes in the optic disc.

In rare cases, simultaneously with papillitis, the layer of nerve fibers that make up the retina becomes inflamed. This condition is known as neuroretinitis. With this form of optic neuritis, Lyme disease, syphilis, viral pathologies, or cat scratch disease usually occur.

Retrobulbar neuritis is localized behind eyeball. The disease does not cause changes in the optic nerve head and therefore this form of neuritis is usually detected after the spread of the inflammatory process into the intraocular part.

Causes of the disease

The causes of the development of optic neuritis in children and adults are mainly due to infectious infection of the body. Pathology can occur when:

Systemic infectious pathologies are capable of causing optic neuritis:

tuberculosis;
typhus;
malaria;
brucellosis;
diphtheria;
gonorrhea and others.

Inflammation of the optic nerve is often observed in complicated pregnancy and traumatic brain injury. Neuritis can be provoked by prolonged alcoholism, diabetes mellitus, blood pathologies, autoimmune diseases.

The course of the pathology provokes inflammatory edema, which causes compression of the optic fibers, leading to their degeneration.

As a result, visual acuity is reduced. At the same time, over time, the intensity of the pathological process decreases and the functions of the eyes are restored. In advanced cases, the inflammatory process causes the breakdown of fibers, in place of which connective tissue is formed. Because of this, atrophy of the optic nerve occurs, which cannot be restored.

The risk group for developing neuritis of the eye includes people aged 20-40 years. More often the disease is diagnosed in women. high risk pathology is observed in multiple sclerosis. This pathology contributes to the demyelination (destruction of the myelin sheath) of nerve fibers.

Symptoms of neuralgia of the optic nerve

With inflammation of the optic nerve, the symptoms and treatment are determined by the form of the disease. The most common is intrabulbar neuritis of the eye, which is characterized by intense manifestation and rapid development.

With this disease, the following symptoms are noted:

Scotomas (blind spots). The main symptom of neuritis. The optic nerve, due to damage, does not conduct all the signals generated by the eye. As a result, the patient does not see separate zones, the size of which varies depending on the neglect of the case.
Myopia (decreased visual acuity). It is diagnosed in 50% of cases. With neuritis, visual acuity is reduced by 0.5-2 diopters. In extreme cases, the patient stops seeing with one eye. Depending on the causative factor and the intensity of the development of the inflammatory process, blindness is reversible and irreversible.
Decreased quality of vision at night. Patients with damage to the optic nerve begin to distinguish objects in the dark with a delay of 3 minutes, when as normal - 40-60 seconds.
Partial or complete absence color perception. With intrabulbar lesions, patients no longer distinguish between shades of colors.

In addition, due to the disease, patients see blurry spots instead of objects. At the same time, the boundaries of the visual fields remain normal.

Symptoms of chronic retrobulbar neuritis of the eye manifest themselves in different ways. This is explained by the structural features of the nerve, which lies freely in the cranial cavity. In case of damage to the inner part of the fibers, signs characteristic of the intrabulbar form of the disease are noted. The development of inflammation on the outer layer provokes pain in the eyes and a decrease in the field of vision while maintaining the same sharpness.

Diagnosis of inflammation of the optic nerve

Symptoms of a pinched optic nerve are characteristic of various pathologies, and therefore this problem is considered in neurology and ophthalmology. To diagnose the disease, a consultation with an ophthalmologist is often enough. At the same time, it is necessary to differentiate optic neuritis with other pathologies similar in symptoms.

With minor lesions, the disease causes subtle changes in the structure of the disc and mild visual disturbances. In this case, fluorescein angiography of the fundus will be required. With this procedure, neuritis is differentiated from diseases of the optic nerve (and others). Additionally, with a similar purpose, lumbar puncture and echo-encephalography are prescribed.

When developing treatment tactics, it is important to take into account the peculiarities of the cause of the disease. To establish it, MRI of the brain, enzyme immunoassay, blood cultures and other examination methods are used.

How to treat the optic nerve?

In case of detection of optic neuritis, treatment is started if the causative factor is diagnosed. If the disease develops against the background of viral infection, then the treatment regimen includes antiviral drugs type "Amixin".

Provided that the bacterial microflora that caused inflammation of the optic nerve is detected, antibiotics are used in the treatment. More often, the strain of the pathogen cannot be diagnosed, therefore, with optic neuritis, antibiotics are used that affect different forms pathogenic microorganisms. In this case, penicillin or cephalosporin drugs are recommended.

To reduce the swelling of the visual disc, glucocorticosteroids are used: Dexameson, Methylprednisolone, Hydrocortisone. With the retrobulbar form of the disease, drugs of this type are injected through a syringe into the fiber located behind the eye. Intrabulbar neuritis is treated with general glucocorticosteroids.

In case of toxic damage to the body, "Reopoliglyukin", "Hemodez" and other detoxification drugs are introduced through a vein through droppers.

An important condition for the successful restoration of the nerve in case of pinching in the eye is the intake of vitamins B1, B6, PP ( a nicotinic acid), Neurobion. These drugs normalize metabolic processes. Taking vitamins improves the conduction of nerve impulses. In stationary conditions, drugs are administered intramuscularly, and when treated at home, they are taken in the form of tablets.

Damage to the optic nerve is also stopped with the help of drugs that improve blood microcirculation: Nicergoline, Trental, Actovegin. These drugs are prescribed after the end of the acute period.

In addition to drug treatment physiotherapeutic methods of correction are applied. Inflammation of the optic nerve is stopped with the help of laser stimulation of the eye, magnetic or electrotherapy.

Treatment of neuritis, carried out at home, is often combined with the use of traditional medicine, but it must first be agreed with the doctor. Shilajit for the treatment of neuritis shows good results. This substance in an amount of 5 g must be mixed with 90 ml pure water and 10 ml of aloe juice. The resulting mixture should be injected one drop into both eyes. The procedure is recommended to be repeated twice a day.

To speed up the recovery of the eye during inflammation of the nerve fibers, a compress of aloe juice (1 tsp) and water (5 tsp) is used. Soak cotton swabs with the resulting product and apply them on the eyes for 15 minutes. Repeat the procedure up to 8 times a day.

Methods of prevention and prognosis of the disease

Prevention of inflammation of the optic nerve is based on the early relief of pathological processes caused by infectious or viral infection. To do this, it is necessary to start treatment on initial stages development of inflammation of the brain, tissues of the nasopharynx, eyes. It is also recommended to constantly use drugs that suppress systemic diseases such as diabetes or tuberculosis.

In view of the fact that toxic damage leads to pathology of the optic nerve, it is recommended to limit consumption or completely abandon alcohol. In addition, it is important to adhere to the principles of a healthy diet.

The prognosis for neuritis directly depends on the degree of neglect of the case, the rate of development of the inflammatory process.

With timely intervention, the functions of the eye are restored within 30 days. However, the patient fully recovers in a few months.

The consequences of optic neuritis are diverse. In extreme cases, the nerve fibers atrophy, causing the patient to go blind in one or both eyes.

Unfortunately, no one is immune from the development of inflammation in the eye. Any such disease causes inconvenience and anxiety. But what to do if suddenly lost vision in 1 eye? Can it be returned? Which specialist treats pathology? It is worth looking into it in detail.

What is this disease?

Neuritis called an inflammatory process that occurs acutely and damages nerve fibers.

Experts distinguish 2 main forms of the disease :

Intrabulbar: inflammation is localized in the initial section of the nerve, not extending beyond the eyeball.
Retrobulbar: pathology strikes visual pathways outside the eye.

Causes

Optic neuritis can occur for the following reasons:

Any eye inflammation: iridocyclitis, uveitis, chorioditis, etc.
Obtaining injuries to the bones of the orbit or their infectious lesions (osteomyelitis, periostitis);
Diseases of the nasal sinuses (sinusitis, frontal sinusitis);
Development of specific infectious diseases: gonorrhea, neurosyphilis, diphtheria;
Inflammatory processes in the brain (encephalitis, meningitis);
Multiple sclerosis;
Dental diseases (caries, periodontitis).

ICD-10 code

In the international classification of diseases, specialists encode the pathology as H46" Optic neuritis.

Symptoms and signs

The disease manifests itself quickly and unexpectedly. The disease is characterized by a unilateral lesion, so most often patients complain of the appearance of symptoms in only 1 eye. The manifestations of the disease largely depend on the amount of damage: the more it is affected by inflammation, the brighter and stronger the symptoms.

Depending on what form of the disease has developed in the patient, its symptoms can manifest themselves in varying degrees: from the appearance of pain inside the eye to a sharp loss of vision.

Symptoms of the intrabulbar form

The first manifestations occur already for 1-2 days, after which their rapid progression is noted. Patients notice the appearance of visual field defects, in which blind spots form in the center of the image. Moreover, patients have reduced visual acuity in the form of myopia or even blindness occurs in 1 eye. AT last case it can become irreversible: the prognosis depends on the start of therapy and the aggressive properties of the pathogen.

A person most often begins to notice a deterioration in vision in the dark: it takes at least 40 seconds to get used to the absence of light and begin to distinguish objects, and about 3 minutes on the side of the lesion. Color perception changes, due to which patients are not able to distinguish some colors.

On average, intrabulbar neuritis lasts about 3-6 weeks.

Symptoms of the retrobulbar form

It occurs much less frequently than the other form. Its main manifestation is considered loss of vision or its noticeable decrease. The disease is characterized by headaches, weakness, fever.

In addition, central blind spots and narrowing of peripheral vision may occur. Often patients complain of the appearance of pain "inside the eye", in the area of the eyebrows.

On average, retrobulbar neuritis lasts about 5-6 weeks.

Diagnostics

To make a diagnosis, methods are used:

- is the main procedure of the oculist, which allows you to examine the fundus. With optic neuritis, the color of the disc is hyperemic, its swelling can be observed, as well as foci of hemorrhage.
FAG (fluorescein angiography): used to clarify the damage to the optic disc: the degree of damage to the nerve by the inflammatory process is revealed. The patient is injected intravenously with a certain substance that “illuminates” the vessels on the retina. Then the ophthalmologist assesses their condition with the help of a fundus camera.

For the retrobulbar form, these methods are not considered informative! The disc begins to change color only after 5 weeks. Therefore, the main diagnosis is the collection of complaints and the exclusion of similar diseases.

Treatment

The goal of therapy is to eliminate the infectious agent. In case of viral damage, the specialist prescribes antiviral drugs (Amiksin), and in case of bacterial infection, antibiotics.

In a real situation, it is not possible to establish the cause of the disease, so the doctor prescribes broad-spectrum antibacterial agents (Penicillin group, Cephalosporins) to all patients suffering from optic neuritis.

Glucocorticosteroid drugs: . They are great at reducing inflammatory reactions and edema of the optic disc. Most often, hormones are administered in the form of a parabulbar injection (into the fiber of the eye).
Detoxification agents: Reopoliglyukin, Hemodez. The specialist prescribes intravenous infusions.
Vitamins of group B, PP. They are necessary to improve the metabolic process in the nervous tissue. The drug is administered intramuscularly.
Medications to improve microcirculation- Actovegin, Trental. They contribute to the normalization of the nutrition of the nervous tissue and are necessary for significant visual impairment and the appearance of visual field defects.
Medications to restore nerve impulse transmission: Nivalin, Neuromidin.

Treatment is carried out by an ophthalmologist together with a neurologist. In addition, with significant violations of visual acuity or visual field defect, physiotherapy is prescribed: electro- and magnetotherapy, laser eye stimulation.

Prevention

Inflammation in the optic nerve is a consequence of other diseases. Therefore, the only measure to prevent the pathological process is the timely treatment of the infectious focus in the body.

Of particular note is the development eye diseases, the causative agent of which is able to spread through the tissues to the optic nerve.

Forecast

In many ways, the outcome of the pathology depends on when the disease was detected by the specialist and anti-inflammatory therapy was started, as well as on the course of the disease. A quarter of patients have a recurrence of optic neuritis, and the pathology can be localized in any eye.

Most often, vision spontaneously returns after 2-3 months. Only in 3% of patients it has not fully recovered and is less than 0.1.

Optic neuritis is a serious and dangerous disease requiring long-term and timely treatment. The sooner the patient receives therapy, the more likely he is to regain vision and get rid of visual field defects.

Video:

Damage to the optic nerve. Optic nerve atrophy (partial and complete) - causes, symptoms, treatment and prevention

Causes of optic nerve atrophy

Classification of optic nerve atrophy

Symptoms of optic nerve atrophy

Diagnosis of optic nerve atrophy

How to treat optic nerve atrophy?

Prognosis for ASD

Prevention

Useful video about optic nerve atrophy

What is the optic nerve?

Causes

Types of disease

Partial atrophy of the optic nerve

Complete atrophy

Symptoms of atrophy

Complications

Diagnostics

Treatment of atrophy of the optic nerve of the eye

Prevention

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Optic nerve damage

Classification of damage to the optic nerve

general information

Causes of damage to the optic nerve

Intrauterine damage to the ON

Inflammatory damage

Non-inflammatory damage

Mechanical damage

Treatment

Causes of damage to the optic nerve

Intrauterine damage to the ON

Inflammatory damage

Non-inflammatory damage

Mechanical damage

Treatment

Video

Structure and functions

Kinds

Causes of the disease

Symptoms of neuralgia of the optic nerve

Diagnosis of inflammation of the optic nerve

How to treat the optic nerve?

Methods of prevention and prognosis of the disease

What is this disease?

Causes

ICD-10 code

Symptoms and signs

Symptoms of the intrabulbar form

Symptoms of the retrobulbar form

Diagnostics

Treatment

Prevention

Forecast

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